Archive for the ‘Quality Improvement’ Category

Attention to high-impact healthcare associated infections can help you get out of the bottom quartile penalty box, according to a new infographic by 3M.

The infographic examines the relative rate of impact on the 2018 penalties for six healthcare associated infections.

Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations set competition aside to collaborate and reduce rehospitalizations from SNFs.

To solidify their coordinated approach, Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System formed the Tri-County SNF Collaborative with support from the Michigan Quality Improvement Organization (MPRO).

The Centers for Medicare & Medicaid Services’ (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was established as a way to measure patients’ perspectives on healthcare and make comparisons across hospitals based on the patient experience. Receiving a high score can boost hospitals’ Medicare/Medicaid reimbursement, while a low score can decrease funding by as much as 2 percent. Because HCAHPS scores can affect a hospital’s bottom line, it provides an incentive for them to place a greater focus on patient experience to receive a high score.

There a number of ways to increase a HCAHPS score, including patient communication and respect, speediness, cleanliness and even pain management procedures. But one way that may be overlooked is how to raise that score through interior design. There are a number of ways to approach HCAHPS scores from a design perspective.

Noise Reduction

With so much commotion in hospitals, it can be difficult for patients to rest, which is a key component to the healing process. Standard noise levels should be 35 dB(A) during the day and 30 d(B)A at night, but peak noise levels in hospitals often exceed 85 to 90 db(A), according to the Center for Health Design.

Aside from limiting overhead announcements and machine beeping, hospitals can reduce noise by focusing on the materials they use inside their facility. Carpet tiles or rubber flooring, as opposed to tile, can reduce the noise of foot traffic outside patient rooms. In addition, acoustic wall coverings and ceiling tiles act as giant sonic sponges, soaking up unwanted noise and echo. This can prevent any loud conversations or unwanted noises from traveling down hallways.

Privacy

Privacy and comfort rank high in ways to improve patient experience. According to the 2016 Hospital Construction Survey, many hospitals are now converting semi-private rooms into private rooms to increase patient privacy. After all, no one wants to share a room with a stranger during what can be one of the scariest times in someone’s life. Plus, two patients in a room can increase the chance of infection.

Many hospitals are also increasing the square footage of patient rooms. This way, even if two patients are sharing a room, they each have plenty of private space.

Personal Controls

To make the hospital feel like home as much as possible, many facilities are now offering patients greater control over the lighting, temperature and window shades in their rooms. Everyone has different preferences when it comes to how warm or cool, or how dark or bright, they want a room to be. Personal dimming controls allow patients to adjust the lighting depending on their activity, whether they are trying to sleep or need extra light for reading or examinations. Giving patients control over these variables can lead to higher patient satisfaction.

Mobility

Hospitals with high mobility and accessibility receive higher HCAHPS scores. Installing handrails makes it easier for patients to get to the bathroom, and wide bathrooms give patients the space they need when using the facilities.

About the Author:

Rebecca Donner

Rebecca Donner is the owner and founder of Nashville-based healthcare interior design firm Inner Design Studio. For more information.

A strong commitment to clinical documentation improvement (CDI) can help healthcare organizations maximize claims reimbursement while improving quality of care, according to a new infographic by Galen Healthcare Solutions.

The infographic examines CDI goals and the impact of improved CDI on the healthcare bottom line.

A laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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As a greater percentage of hospital payments are through value-based contracts, hospitals that reduce costs while maintaining quality will survive, predicts Pam Rush, cardiovascular clinical service line program director at Allina Health.

How can we be more creative and do things differently? How can we use different members of the healthcare teams in new ways, such as nurse practitioners or advanced practice providers, she added. In addition, “we need to invest in data analytics and data resources and have data analysts who can pull the information for us so we can find the variation. We need to invest in physician and caregiver time to look at the data, to make changes in how they improve care, to monitor and see what is working and what doesn’t work.”

These four pillars…population health management, reducing clinical variation, testing new care processes and new models of payment, and leveraging cutting edge technologies…have been critical to the work at Allina Health System’s Minneapolis Heart Institute Center for Healthcare Delivery Innovation, said Rush.

In population health management, we’re looking at how can we focus on adherence to guidelines, identify where there are gaps in care and partner with people across the system, primary care and specialists, to improve consistency and adherence to guidelines, she explained.

Allina is reducing clinical variation by looking at unnecessary variations in care where there is inconsistent care without an influence on outcomes.

“We’re also looking at new ways of doing things. How can we use our nurse practitioners, how do we care for patients once they’re discharged from the hospital and bring them back in for clinic visits? It’s really looking at the care model and how we can do things differently to reduce total cost of care,” she said.

In cardiology, there are so many new devices, procedures and techniques to monitor, said Rush, but we need to figure out who are the right providers to do that monitoring, who are the right patients to do these expensive procedures on and who achieves the best outcomes, because we can’t afford to do all of this new technology to every single person.

Allina looks at these four pillars across the continuum. Starting in primary care to partner on prevention strategies, moving to who gets referred to cardiology, and when they’re referred to cardiology, what are the set of tests or treatments and guidelines to adhere to along the continuum to subspecialties, emergency services and all the way up through advanced therapies, such as transplant.

During the webinar, Rush along with Dr. Steven Bradley, cardiologist, MHI and associate director, MHI Healthcare Delivery Innovation Center, shared these four pillars of predictive analytics success along with details on creating a culture of quality and innovation, building performance improvement dashboards, as well as several case examples of quality improvement initiatives contributing to these savings and much more.

The Institute of Medicine set a goal that 90 percent of all healthcare decisions will be evidence-based by 2020. Executives and nursing leaders, at all levels within organizations, have clear responsibility for making this goal a reality and ensuring consistent, standardized use of evidence-based practice (EBP) in care delivery that will meet patient, family, clinician, and organizational outcomes.

Promoting use of evidence, valuing questioning of clinical and administrative practice, and building organizational capacity, culture, and commitment are pivotal to building a supportive organizational culture related to EBP.

Organizations must meet regulatory requirements, from the Centers for Medicare and Medicaid Services and The Joint Commission, that incorporate EBPs and the need for increasing public accountability and transparency (e.g., use of national benchmarks) for quality and safety. Financial incentives associated with pay-for-performance are also directly linked to EBP. Despite these outside forces in today’s healthcare environment, clinicians and executives cannot forget about the need to provide individualized patient care, which includes patient engagement strategies aimed at improving the overall patient experience.

EBP is a continuous journey for individual clinicians and organizations alike and starts with building organizational capacity.

Organizational Capacity

EBP capacity is built using a strategic, systematic approach to create a solid foundation and infrastructure to support the work. Before EBP work can be successful at the unit or clinic level, EBP must be integrated at the organizational level and a culture for change must exist.

The organization’s mission, vision, and strategic plan must include EBP language to ensure evidence-based healthcare is clearly portrayed as the organizational norm. Creating a culture valuing inquiry and innovation must start during orientation for new hires and continue during competency review for current employees and through ongoing training and professional development opportunities for both clinicians and executive leaders.

An infrastructure that directly integrates EBP work into the organizational governance structure is needed to support the mission, vision, and strategic plan. A crucial organizational decision is determining what group will hold primary accountability or functional responsibility for EBP to ensure it is integrated into practice processes, policies, and documentation.

Recruiting and hiring clinicians and executives with experience and/or interest in EBP will help build the desired culture and capacity. EBP mentors are developed from successful projects and are used to nurture the next generation.

A well-defined path for EBP includes adoption of an EBP-process model to guide implementation and sustained organizational change across disciplines. There are a number of EBP process models: The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care; Johns Hopkins Nursing Evidence-Based Practice Model; Stetler Model of Evidence-Based Practice; and Advancing Research and Clinical Practice Through Close Collaboration (ARCC) Model. Each model follows a step-by-step problem-solving process suitable for concurrent use with the organization’s quality improvement processes.

Culture

The governance structure must clearly outline the process and channels for communicating EBP work and obtaining necessary approvals from applicable committees. EBP discussions should be a regular agenda item for all shared governance committees.

Project results should be reported internally through the organization’s shared governance and quality improvement structures to promote practice change adoption, share learning, garner continued support (e.g., time, resources), and as a platform to recognize success for the institution’s EBP program.

Successful EBP work takes time and effort, so successes should be celebrated and rewarded throughout the process. Celebrations are an opportunity to spotlight clinicians for doing this work and helps build a pervasive culture that supports and expects use of evidence in practice. These strategies promote organizational buy-in and commitment for the EBP process and set higher standards as a foundation for future efforts.

Expected behaviors from clinicians across all job classifications at every level must clearly demonstrate the value of EBP. Behavioral expectations regarding EBP are easily set if they are built into every job description and can be quickly reviewed annually during the performance appraisal process. Utilizing documents and mechanisms that already occur is an easy and efficient way to promote positive reinforcement and priority setting in busy work environments with many ongoing and competing demands for clinicians’ and leaders’ time and attention.

Benefits

EBP is value-added with a strong return on investment and responds to current priorities. A single project may improve patient and clinician safety, improve clinical outcomes, improve patient/family satisfaction, promote innovate care, and/or reduce costs.

Clinicians, nurses, and leaders all influence an organization’s capacity for EBP. Leaders who demonstrate and expect EBP will promote its use in clinical and operational decision-making at the unit or clinic and organizational levels. Building on the organization’s mission, vision, capacity, and value for delivery of reliable, safe, high quality care provides a foundation for success.

About the Authors:

Michele Farrington, BSN, RN, CPHON, is a clinical healthcare research associate at the University of Iowa Hospitals and Clinics. She is certified in pediatric hematology/oncology nursing and received her BSN from the University of Iowa. She has been leading, co-leading, or mentoring EBP initiatives since 2003, and her work has been awarded extramural funding, validating the strength of the projects and impact on nursing care. She is widely published and has given multiple local, regional, national, and international presentations.

Cindy Dawson, MSN, RN, CORLN, is the chief nurse executive and associate director of the University of Iowa Hospitals and Clinics. She received her BSN from the University of Iowa, MSN from the University of Phoenix, and is a Certified Otorhinolaryngology Nurse. Over the course of her career, she has published extensively on EBP, nurse triage, nursing management/leadership, and clinical practice guidelines and has given numerous local, regional, national, and international presentations on these topics.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remains with them. The company accepts no liability for any errors, omissions or representations.

Increases in life expectancy, changing consumer behavior, political uncertainties, inflation and rising number of chronic diseases are helping to drive the digital health transformation demand, according to a new infographic by InsightRush.

The infographic examines how each of these factors is contributing to the digital health transformation.

Digital health, also referred to as ‘connected health,’ leverages technology to help identify, track and manage health problems and challenges faced by patients. Person-centric health management is slowly acknowledging the device-driven lives of patients and health plan members and incorporating these tools into care delivery and management efforts.

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.

Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.

Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.

Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.

CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

More than 70 percent of healthcare organizations have created formal patient engagement initiatives, according to 2017 benchmarks from the Healthcare Intelligence Network.

To identify individuals that are poorly engaged in their health, nearly two-thirds (63 percent) of healthcare organizations mine clinical data analytics, according to the 2017 Patient Engagement Survey by the Healthcare Intelligence Network, while 37 percent screen patients for social determinants of health related to housing, care access, transportation, nutrition and finances.

Patients who screen positive for social determinants of health (SDOH) and individuals with diabetes are typically the most difficult populations to engage, according to 2017 survey benchmarks.

Thirty-five percent of respondents to the September 2017 survey said the presence of SDOHs, which the World Health Organization defines as “conditions in which people are born, grow, live, work and age,” pose the greatest challenge to health engagement, while 26 percent said a diabetes diagnosis presents the top clinical challenge to engagement interventions.

To improve engagement, 75 percent of respondents rely on education of patients, family and caregivers, supported with telephonic outreach (13 percent) and home visits (13 percent).

Efforts by 71 percent of respondents to create a formal patient engagement program underscore the critical role of engagement in healthcare’s value-based care and reimbursement models, particularly in regards to chronic illness.

In other survey findings:

Patient experience rankings are the most reliable measure of engagement program success, say 43 percent.

For one quarter of respondents, patient engagement is the primary domain of case managers.

Eighty-three percent saw quality metrics improve as a result of patient engagement efforts.

The shift to value-based payment is a slow one, with most health plans not yet making the transition to risk, according to a new infographic by HealthScape Advisors.

The infographic examines the percentage of plans in upside and downside risk contracts, the impact of health plan sponsor on risk contracts, cost and quality impacts for risk contracts, value-based payment enablers and recommendations for success in value-based contracts.

The accountable care organization, or ACO, has become a cornerstone of healthcare delivery system and payment reform by raising the bar on healthcare quality and reducing unnecessary costs. There are now more than 700 ACOs in existence today, by a 2017 SK&A estimate.

Download this FREE report for data on the top clinical targets of healthcare case managers; the top means of identifying and stratifying individuals for case management; and the most common locations of embedded or colocated case managers.